Tag: Pregnancy Article

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Advocating for Yourself in the Medical Community

It’s important to speak up for yourself when visiting the doctor, especially for women who might feel overlooked. Sometimes, doctors may not fully understand the unique needs of underrepresented women, like those from different races or backgrounds. If you feel your concerns aren’t being heard, it’s okay to ask more questions or even get a second opinion. Make sure to share all your symptoms, ask for explanations if you don’t understand, and keep notes of your visits. Remember, your health is important, and you deserve to be treated with care and respect.

Research has shown that women, particularly women of color, may receive different treatment from doctors than others. This is why it’s so important to ask about all your options and insist on the best care possible. Don’t be afraid to trust your instincts and push for what you need to feel better.

One way to practice advocating for yourself is by asking for more information about your diagnosis. For example, if your doctor says you don’t need any tests, but you still feel sick, you can say, “I’m still feeling unwell, and I’d like to understand why. Can we look into other options or tests?” This helps make sure your concerns are taken seriously.

References:

Hagan Thomas, T., Vetterly, S., Kaselitz, E. B., Doswell, W., & Braxter, B. (2024). A Qualitative Exploration of Self‐Advocacy Experiences of Black Women in the Perinatal Period: Who Is Listening?. Journal of Midwifery & Women’s Health. https://doi.org/10.1111/jmwh.13630 

Hutchens, J., Frawley, J., & Sullivan, E. A.. (2023). Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum. International Journal of Qualitative Studies on Health and Well-being, 18(1). https://doi.org/10.1080/17482631.2023.2182953

Treder, K., White, K. O., Woodhams, E., Pancholi, R., & Yinusa-Nyahkoon, L. (2022). Racism and the reproductive health experiences of US-born Black women. Obstetrics & Gynecology, 139(3), 407-416. 10.1097/AOG.0000000000004675

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Pregnancy Article Weekly Tips

Weight Gain for Twin Pregnancies

The Institute of Medicine has established some general guidelines for total weight gain in twin pregnancies based on pre-pregnancy body mass index (BMI). To determine your pre-pregnancy BMI, enter your weight and height PRIOR TO PREGNANCY at this link (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html).

Once you have a value, use the table below to determine how much total weight you should gain.

Of note, it is not entirely clear how much a woman carrying twins with a BMI <18.5 should gain during pregnancy. For all women carrying twins, it is important to engage in frequent conversations about weight gain with your health care provider to ensure your babies are growing properly, and that you are staying healthy as well!

Citation:

Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. https://doi.org/10.17226/12584.

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F.I.T.T.

F.I.T.T. Framework for Pregnancy

F.I.T.T. stands for frequency, intensity, time, and type of exercise. This framework can help you decide on exercise programming that works for YOU and YOUR schedule! The ultimate goal of using BumptUp is to hit 150min of moderate exercise per week. Use this framework to help you do that!

Frequency- aim for exercising at least 3-4 times per week (but work up to daily)

Intensity– Shoot for an intensity that makes your heart beat faster and breath harder, but keep it to where you can still carry on a conversation. This is called the “talk test” and can keep you at a level that is not going to overexert yourself. If you are a very active person and used to more intense activity, it is okay to work even harder!

Time– anywhere from 20-60 minutes. Note: it is okay to break this up into 10min sessions throughout the day!

Type– This part should be based purely on what YOU enjoy doing the most! If you love to walk, walk! If you like to run, run! If you like to cycle, cycle! If you like to play tennis, play tennis! If you like to dance, dance! Choose a mode that sets you up to be successful! And if you don’t know what you like to do, visit our full body workout section of the app!! We can help you pick safe and effective exercises to create your own workouts!

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Can Exercise Help my Labor Get Started?

You’re a day past your due date and anxious to get the show on the road. You may have wondered what you can do to get things started and questioned whether a fast walk around the block may do the trick.

If you’ve been exercising throughout your pregnancy, it’s fine (and even advisable) to continue with your routine past your due date. Even if you haven’t been keeping fit, short walks are an excellent way to keep yourself focused and reduce pre-labor anxiety. As long as your feeling good and your doctor or midwife hasn’t asked you to avoid exercise, keep doing whatever activity feels best.

Although you may have heard other pregnancy women say that a run or fast walk brought on labor, the jury is out regarding whether exercise in itself can nudge labor. What little data there is on this subject hasn’t shown an association between physical activity and going into labor, but that doesn’t mean exercise isn’t helpful during those long days of waiting.

Many women who’ve exercising throughout their pregnancy have biked, ran, walked, or worked out in a gym the day they went into labor. We even know one woman who biked into the hospital to deliver her baby. These women would probably agree that exercising right up to when labor started made a big difference in how they felt during and after labor and delivery. Here are just a few of the perks:

  • Exercise is a great stress and anxiety reducer. Most women are a little nervous before they go into labor and exercise can reduce stress hormones.
  • Exercise helps to improve focus—helping you with your preparation for labor and delivery, as well as planning for your baby’s arrival home.
  • Physical activity helps boost self-esteem and mental outlook. A positive outlook can help reduce pain, anxiety, and fear during labor and delivery.

Although you may feel impatient for your labor to start once you’ve reached your due date, it’s important to remember that normal gestation can vary between 38-42 weeks, with some pregnancies (called post-term) can go beyond 42 weeks.  The following factors can increase the incidence of going past your due date:

  • Hormonal influences.
  • Obesity.
  • Genetic factors (if you were born post-term you might have a higher chance of your baby being the same).
  • First-time pregnancy.

With that in mind, don’t feel that you’re abnormal if you don’t feel anything happening at your due date—you and your healthcare provider can best determine whether you need to be induced or just sit tight until nature takes its course.

Internet Journal of Gynecology and Obstetrics

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Weekly Tips

Constipation

Constipation is a common complaint during pregnancy likely due to changing hormone levels, diet changes, increased pressure from your growing baby, and a change in activity levels. If you are suffering from constipation, try these tips to get your bowels moving.  

Hydrate

Make sure you’re getting an adequate intake of water throughout the day. Pay attention to your body and drink when you are thirsty. Tea, coffee, and soft drinks are not a replacement for water. Hydration is like the three little pigs: you do not want too drink too little, which can contribute to swelling, constipation, and other symptoms, or too much, which can overload your bladder and lead to increased frequency of urinating. You want to find the sweet spot of “just right” which can be accomplished by paying attention to your body. This may mean you need to “check in” a few times a day to ask yourself if you are feeling thirsty.

Fiber

Foods high in fiber such as apples, avocados, and brussels sprouts can help. Aim for 28g of protein per day during pregnancy. You can also consider adding flax seed or psyllium husk to your yogurt, smoothies, or oatmeal for added fiber (start with 1 teaspoon per day and increase to 2 tablespoons depending on tolerance).

Activity

Move your body to help reduce constipation. Go for a walk, try a yoga or mobility flow, or lift weights to get in your recommended exercise intake plus help your bowels become more regular. There are also several specific exercises that can help. These include hip swings, hook-lying trunk rotation, and quadruped rocking.

Positioning

Using a stool or squatty potty to get the knees above your hips can help your bowels move more freely while on the toilet. Working with a PFPT to learn how to fully relax your pelvic floor may also be beneficial.

Food Sensitivities

Some foods may be contributing to your constipation during pregnancy. If you’ve tried all of the tips above and still experience constipation, ask your OBGYN, midwife, or pelvic floor physical therapist for a referral to a prenatal Registered Dietitian that can help you work through your diet.

Self or Partner Abdominal Massage

This massage designed specifically for constipation is sometimes called the “I Love You” massage because you are tracing the letters “I” “L” and “U” over your belly. While you are not actually pushing stool through your intestines, this massage technique helps to move the tissues around your organs to help things move more easily through the system. It is normal and safe to hear your tummy talking back to you with gurgles while performing the massage but if you do not hear or feel gurgles that is ok too! This is usually performed for 10 minutes and performance is recommended just before bed or as soon as you wake up in the morning.

Watch video below on abdominal massage:

https://vimeo.com/forerunnerbg/download/686023078/48b5dd6d05

Habit Training

The best time to have a bowel movement is in the morning about 30 minutes after waking due to gastrocolic reflex. Waking up and drinking a water beverage (i.e. warm water), moving (i.e. walking around the house), and eating (specifically the mechanical action of chewing) all augment the gastrocolic reflex. Another good time to try and have a bowel movement is 30 minutes after a meal. You can go in the bathroom and sit on toilet for no longer than 5 minutes. This can “train” the bowels. This can be even more effective postpartum. 

Toileting Mechanics

When on the toilet, pull pants and underwear down to ankles to allow legs to relax out to the side

When you bear down, instead of holding your breath, blow out through your mouth as if blowing through a straw. You can also make a sound like “SSSSHHHH” “HHAAAAA” “GGGRRRR”. You can also hum or sing. The goal is to be breathing as you push to protect your pelvic floor. 

As you bear down, imagine “belly big belly hard”, trying to make your belly big like a basketball. 

If nothing is happening, you can rock side to side, front and back on the toilet. You can also make circles with you pelvis and trunk clockwise and counterclockwise.

References:

Jewell D, Young G. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD001142. DOI: 10.1002/14651858.CD001142. Accessed 29 January 2022.

Rungsiprakarn P, Laopaiboon M, Sangkomkamhang US, Lumbiganon P, Pratt JJ. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011448. DOI: 10.1002/14651858.CD011448.pub2. Accessed 29 January 2022.

Casey Thomas-Hardesty, MS, NTP & Jenny LaCross,PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Weekly Tips

Nutrition for 2nd Trimester

Welcome to the 2nd trimester. Now that you (hopefully) have your appetite back, you may feel more comfortable incorporating meats and vegetables back into your diet. Below are some tips and ideas to help you through these next several weeks.

Salads

While leafy greens may have been a turnoff during the first trimester, many people find them appealing once again during the remainder of their pregnancy. Don’t just opt for plain lettuce though. Here are some salad toppers that can help you increase your nutrient intake:

– salmon, diced chicken, or hard boiled eggs

– nuts and seeds like pumpkin seeds, slivered almonds, or walnuts

– fruits and vegetables like apples, carrots, and broccoli

– don’t forget the dressing and healthy fats

Easy Meals

Similar to snack plates, putting together quick and easy meals can be a great option for weekday meals.

– tuna salad (look for skipjack or brands with low mercury), whole wheat crackers, apples, and carrots

– breakfast for dinner – scrambled eggs with veggies, whole grain toast with butter, and a side of berries

– sheet pan dinners – one pan dinners help make cooking and cleanup easy. Try mixing vegetables like baby potatoes, carrots, and zucchini on a sheet pan. Toss with olive oil and your preferred spice blend, add in chicken thighs, and cook until chicken reaches an internal temperature of 165 degrees Fahrenheit.

Note: For food storage safety guidelines, click here.

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

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Nutrition for 1st Trimester

Food aversions and fatigue can make obtaining adequate nutrition difficult in your first trimester. Below are some quick and easy ideas to help you make a balanced plate during the first 12 weeks of pregnancy.

Snack plates

You don’t have to have a traditionally prepared meal to hit all of the macronutrient categories. Try mixing together a snack plate that includes protein, healthy fats, and carbohydrates for a well-rounded meal.

– whole grain crackers, snap peas, baby carrots, sliced apples, nut butter or hummus

– avocado toast and two hardboiled eggs

Smoothies

Smoothies make great options for breakfast when nausea may be higher. Make sure you’re including protein to help keep you full longer. Greek yogurt and nut butters are good protein sources to add to your smoothie. A plant or whey based protein powder is another good option. Just make sure to check the ingredients. Ideally, protein powders would be third party tested, have no caffeine or artificial sweeteners, and have minimal quality ingredients.

One of my favorite smoothies combines

– 1 cup almond milk (or your milk of choice)

– 2 handfuls spinach

– 1-2 scoops protein powder

– 1 Tbsp almond butter

– 1 tsp unsweetened cocoa powder

– ¾ cup frozen blueberries

– ice to reach desired consistency

Textures

Play around with food textures. A steak may not sound appealing right now but ground beef is ok. Similarly, scrambled eggs may be a turn off but hard boiled eggs are a go. Feel free to experiment to see what works for you during these first 12 weeks.

Note: For food storage safety guidelines, click here.

Casey Thomas-Hardesty, MS, NTP

Two Peas Wellness

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How to Safely Maintain Core Strength During Pregnancy

Among the many physical changes of pregnancy is an ever-expanding tummy.  As your abdomen grows, the muscles that provide support for your core need to remain strong and require a shift in the type of exercises required to build strength. 

Pregnancy-induced changes cause the connective tissue that joins the two sides of the rectus abdominis muscles “six-pack muscles” (they span vertically from your ribs to pelvis) to thin and widen, separating the recti muscles’ two sides. This thinning and widening of the two recti muscles’ distance is called a “diastasis recti.”

The development of a diastasis recti is extremely common during pregnancy, especially third trimester, and postpartum. It is not pathologic unless it interferes with activities and quality of life. The incidence and degree of separation can be increased by:

  • Rapid changes in weight
  • Obesity
  • Genetics
  • Age
  • Multiple pregnancies
  • Poor body mechanics

It’s important to be aware of the tension put on the diastasis recti to help avoid increasing tension and further separation. It is important to be mindful of movements that may increase midline tension.

What to avoid:

  • *Sit up type exercises (puts a lot of pressure on your midline with the loaded spinal bending). However, after delivery or in the 4th trimester, consult with a pelvic health physical therapist for exercise recommendations on how to optimize rectus abdominus function, which will likely include curling up types of activities.
  • *NOTE: This type of curling exercise can be very helpful when performed correctly at the appropriate time. If you have questions, consult with a pelvic health physical therapist.
  • Poor body mechanics (twisting when lifting, raising up from a supine position without support).
  • lifting heavy objects if that is not part of your normal pre-pregnancy exercise routine.
  • Bearing down while holding your breathe when lifting or toileting.

Improving abdominal support with proper exercises can help prevent musculoskeletal discomfort and speed postpartum abdominal recovery. As your pregnancy progresses, you won’t be able to strengthen core muscles with this movement effectively.

Instead, focus on exercises that target the transverse abdominis muscle, a corset-like band of muscle that is crucial for maintaining good belly support.

Best abdominal exercise for pregnancy:

  • Isometric contractions of the transverse abdominis in a variety of positions (sitting, standing, on hands and knees, side lying)
  • Supine and modified supine (after the first trimester) leg slides and knee raises and extensions. NOTE: this does not apply to everyone. If you are a weight lifter or avid exerciser, then these may be way too easy and not load your tissues enough. This is more for women who are inactive or minimally active leading into pregnancy.
  • Working functionally to provide abdominal support with movement by making a habit of tightening the lower tummy and holding as you lift, bend, and move. Make sure to match the amount you’re tightening with the difficulty of the task. You do not need to tighten as much when lifting a kleenex. You should tighten more if lifting a heavy grocery bag. Think about the muscle as a “dimmer switch” with the ability to span a range of tightness as opposed to an “on/off” switch. 
  • Use your breathing to enhance your ab exercises by blowing out as if trying to fog your glasses to clean them as you are doing each contraction (you’ll feel how that pulls your tummy inward).
  • Practice the “basic breath” where contract your lower tummy and pelvic floor and hold as you keep breathing normally. Use the basic breath to tighten your tummy and pelvic floor before lifting.

Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1–8

Berg-Poppe P, Hauer M, Jones C, Munger M, Wethor C. Use of exercise in the management of postpartum diastasis recti: A Systematic Review. J Women’s Health Phys Ther. 2022;46(1): 35-47. doi: 10.1097/JWH.0000000000000231

Dufour, Sinéad PT, PhD1; Bernard, Stéphanie PT, MSc2; Murray-Davis, Beth PhD, RM3; Graham, Nadine PT, MSc1 Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study, Journal of Women’s Health Physical Therapy: April/June 2019 – Volume 43 – Issue 2 – p 73-81 doi: 10.1097/JWH.0000000000000130

Catherine Cram, MS and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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How Can Exercise During Pregnancy Affect Labor & Delivery?

You probably already know that exercise helps your body deal with pregnancy changes by keeping you strong and flexible. But, did you know that maintaining an exercise routine throughout your pregnancy may help you have a lower chance of a complication during your labor and delivery?

Research in the field of prenatal exercise has suggested that there may be birthing benefits that include a lower incidence of preterm labor and cesarean section in women who exercised to the end of their pregnancy. Some research has found that exercise significantly reduce the duration of the second stage of labor in women who exercising throughout pregnancy. Exercise, such as walking, during pregnancy can also lower the odds of you needing to be induced! There’s even evidence that exercise such as yoga may help ease pain perception during labor—possibly by training the mind to focus more effectively and incorporate relaxation techniques during times of stress. Knowing that exercise may positively impact your labor and delivery can provide even more motivation to keep fit.

Here are the takeaway points for improving your odds of complication-free labor and delivery:

  • Do some type of aerobic exercise 5-6 days a week.
  • Add flexibility training and yoga to your routine.
  • Make sure you strength train three days a week.
  • Modify your fitness routine as needed so you’re able to continue exercising to the end of your pregnancy (that’s important for keeping weight gain within normal limits and, in turn, keeping baby weight from getting too high, which can increase the risk of C-section).

References

Am J Obstet Gynecol 2017;216:335–7.Berghella V, Saccone G. Exercise in pregnancy

J Gynecol Obstet Hum Reproduction 2020 Jun;49(6):101736. The effect of antenatal exercise on delivery outcomes: A systematic review and meta-analysis of randomized controlled trials. Ahmed Taher Masoud1, Mohammed M AbdelGawad1, Norihan Hatem Elshamy1, Omar Magdy Mohamed1, Zeinab Y Hashem1, Ahmed K Abd Eltawab1, Ahmed Samy2, Ahmed M Abbas

Int J Environ Res Public Health. 2020 Aug; 17(15): 5274.  Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery, and Pregnancy: A Retrospective Study

Yogyata Wadhwa,1 

Pereira IB, Silva R, Ayres-de-Campos D, Clode N. Physical exercise at term for enhancing the spontaneous onset of labor: a randomized clinical trial [published online ahead of print, 2020 Mar 29]. J Matern Fetal Neonatal Med. 2020;1-5. doi:10.1080/14767058.2020.1732341

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Mental Health During Pregnancy

If you fell and broke your leg, you wouldn’t hesitate to call your doctor and seek help. Mental health is just as important as physical health! If you think you are depressed, stressed, anxious, or sadder than normal during pregnancy, you should talk to your doctor.

One in every four pregnant women experience a mental health concern, and this is nothing to be ashamed of! That is almost 4 times more common than gestational diabetes, yet all pregnant women get screened for that and talk openly about the results. For some women pregnancy is the happiest time of their life, for others, it is a really difficult time both mentally and physically. A big change is on the horizon, and change can be stressful! Just because you feel sad, doesn’t mean you don’t love your unborn baby or that there is anything wrong with you! This can be totally normal!! Pregnancy is hard enough without the added challenge of fighting mental health concerns. There are many options for helping you to feel better and be the happiest version of yourself!

https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric Disorders in Pregnant and Postpartum Women in the United States. Arch Gen Psychiatry. 2008;65(7):805–815. doi:10.1001/archpsyc.65.7.805

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